Provision of HIV treatment can be cost-saving for companies in high prevalence settings

In settings with a high prevalence of HIV, such as South Africa, provision of antiretroviral therapy programmes in the workplace can be cost saving for companies due to reductions in healthcare costs, absenteeism, and staff turnover according to new research by Gesine Meyer-Rath, from Boston University and the University of the Witwatersrand, Peter Vickerman, from University of Bristol, and other colleagues published this week in PLOS Medicine. The analysis was the result of a long-standing collaboration with the London School of Hygiene and Tropical Medicine, UK, and the Aurum Institute, South Africa.

Every year, more than 2 million people become newly infected with HIV, the virus that causes AIDS, usually by having unprotected sex with an infected partner. HIV can affect individuals in the prime of their working lives, thereby increasing absenteeism and turnover of the workforce as well as the operating costs of companies working in countries where HIV infection is common.

In their study the authors developed a mathematical model to evaluate the past and future impact and costs to the employer of an antiretroviral treatment program provided since 2002 by a coal mining company operating at a number of South African mines. The company was one of the first to provide services for HIV-infected employees in a poor country, and provided HIV therapy years before it was available in the government sector. By the end of 2010, out of 9,252 employees, 1,149 had tested HIV positive in confirmatory tests and had been enrolled in the company's wellness programme.

The authors' model estimated that, as ART coverage increased from 10% to 97% of eligible employees, increases in the survival and retention of HIV-positive employees and reductions in absenteeism and benefit payments would lead to overall cost savings compared to a scenario of no antiretroviral treatment provision. Specifically, the annual cost of HIV to the company would decrease by 5% and the average cost per HIV positive employee would decrease by 14% by 2022.

Although the authors acknowledge some limitations, for example that the analysis did not examine the impact of HIV prevention policies on the miners or their families, and a few model inputs were based on limited data, the changes in costs were robust to a very detailed examination of the uncertainty in the data and translate into average savings of nearly US$1 million per year. Importantly, they found that even in a country with very low HIV prevalence, ART would still save companies money compared to no ART provision. These savings mainly accrue from reductions in benefit payments for death and ill-health retirement and in employee healthcare costs.

The authors conclude, "Beyond making good business sense, a company-level HIV care programme including ART could go a long way towards improving the strained labour relations in the South African mining sector, especially when improved access to healthcare extends to the entire community... It is crucial that strategies such as those under study here are replicated in other companies in similar settings."

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Research Article

Funding: Funding for this study was obtained through a grant by GlaxoSmithKline to the Aurum Institute and direct funding from Anglo American. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: GC is employed by the Aurum Institute, which received a small donation over the past few years from the Anglo American Chairman's fund. At the time of conception and design, acquisition of data, analysis and interpretation of data as well as at the time of the drafting of the article and revising it critically for important intellectual content, BB was employed by Anglo American as their Chief Medical Officer (previously designated Senior Vice President: Medical and/or Group Medical Consultant). He retired from Anglo American on 31st December 2014, but continued to have a part-time consultancy contract with the Company. The research work was carried out through the health services of Anglo American Coal mines in South Africa, for which BB was responsible for overarching professional oversight as Chief Medical Officer of Anglo American plc. The research work was partly funded by Anglo American Operations Limited, through a budget for which he was responsible. BB is an independent non-executive director of Right to Care (nonprofit company), which has a close working relationship with Gesine Meyer-Rath's Health Economics and Epidemiology Research Office through shared directors.

Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America
Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Highveld Hospital, Anglo American Coal, Emalahleni, South Africa
Anglo American, Johannesburg, South Africa
The Aurum Institute, Johannesburg, South Africa
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom

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